Adult Health I: Chapter 51: Assessment and Management of Patients With Diabetes

A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds:

Correct response: 180 mg/dL Page 1459

A client with diabetes mellitus has a blood glucose level of 40 mg/dL. Which rapidly absorbed carbohydrate would be most effective?

You Selected: 1/2 tbsp honey or syrup Correct response: 1/2 cup fruit juice or regular soft drink Page 1482

A client with type 1 diabetes is scheduled to receive 30 units of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client:

Correct response: 9 units regular insulin and 21 units neutral protamine Hagedorn (NPH). Explanation: Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 51: Assessment and Management of Patients With Diabetes, Mixing Insulins, p. 1479. Chapter 51: Assessment and Management of Patients With Diabetes - Page 1479

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating:

Correct response: "It tells us about your sugar control for the last 3 months."

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response? "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood." "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released." "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid." "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."

Correct response: "Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy." Page 1467

A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction?

Correct response: "Rotate injection sites within the same anatomic region, not among different regions." Page 1479

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:

Correct response: 10 to 15 g of a simple carbohydrate. Page 1482

A female diabetic patient who weighs 130 lb has an ideal body weight of 116 lb. For weight reduction of 2 lb/week, approximately what should her daily caloric intake be? 1000 calories 1200 calories 1500 calories 1,800 calories

Correct response: 1000 calories Page 1462

A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by:

Correct response: 8:30 AM. Page 1468

Which statement is true regarding gestational diabetes? It occurs in the majority of pregnancies. Onset usually occurs in the first trimester. A glucose challenge test should be performed between 24 to 28 weeks. There is a low risk for perinatal complications.

Correct response: A glucose challenge test should be performed between 24 to 28 weeks. Page 1459

A client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate?

Correct response: Administering 1 ampule of 50% dextrose solution, per physician's order

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate?

Correct response: Albumin Page 1492

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client? Arterial pH 7.25 Plasma bicarbonate 12 mEq/L Blood glucose level 1,100 mg/dl Blood urea nitrogen (BUN) 15 mg/dl

Correct response: Blood glucose level 1,100 mg/dl

A client with diabetes mellitus is receiving an oral antidiabetic agent. The nurse observes for which symptom when caring for this client? Polyuria, Hypoglycemia, Blurred vision, or Polydipsia?

Correct response: Hypoglycemia Page 1473

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?

Correct response: Hypokalemia and hypoglycemia Page 1485

A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites? Insulin is absorbed more slowly at abdominal injection sites than at other sites. Insulin is absorbed rapidly regardless of the injection site. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Insulin is absorbed unpredictably at all injection sites.

Correct response: Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Page 1479

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? It carries glucose into body cells. It aids in the process of gluconeogenesis. It stimulates the pancreatic beta cells. It decreases the intestinal absorption of glucose.

Correct response: It carries glucose into body cells. Page 1457

A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer? Metformin, Glyburide, Repaglinide, or Glipizide?

Correct response: Metformin Page 1460

The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer?

Correct response: NPH Page 1468

The nurse is explaining glycosylated hemoglobin testing to a diabetic client. Which of the following provides the best reason for this order? Provides best information on the body's ability to maintain normal blood functioning Best indicator for the nutritional state of the client Is less costly than performing daily blood sugar test Reflects the amount of glucose stored in hemoglobin over past several months.

Correct response: Reflects the amount of glucose stored in hemoglobin over past several months. Page 1467

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously? Glargine Regular NPH Lente

Correct response: Regular Page 1485

After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias?

Correct response: Serum potassium level Page 1485

Insulin is a hormone secreted by the Islets of Langerhans and is essential for the metabolism of carbohydrates, fats, and protein. The nurse understands the physiologic importance of gluconeogenesis, which refers to the: Transport of potassium. Release of glucose. Synthesis of glucose from noncarbohydrate sources. Storage of glucose as glycogen in the liver.

Correct response: Synthesis of glucose from noncarbohydrate sources. Page 1459

Which of the following factors would a nurse identify as a most likely cause of diabetic ketoacidosis (DKA) in a client with diabetes? The client continues medication therapy despite adequate food intake. The client has not consumed sufficient calories. The client has been exercising more than usual. The client has eaten and has not taken or received insulin.

Correct response: The client has eaten and has not taken or received insulin.

A male client, aged 42 years, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client? The client's consumption of carbohydrates History of radiographic contrast studies that used iodine The client's mental and emotional status The client's exercise routine

Correct response: The client's consumption of carbohydrates Page 1462

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise:

Correct response: at least three times per week. Page 1465

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition? ketoacidosis hyperosmolar hyperglycemic nonketotic syndrome hepatic disorder All options are correct.

Correct response: ketoacidosis

A client has been diagnosed with prediabetes and discusses treatment strategies with the nurse. What can be the consequences of untreated prediabetes? CVA Type 2 diabetes Cardiac disease All options are correct.

Correct response: All options are correct.